Over 60 years ago the BMJ reported an association between mental illness and poor physical health.1 Subsequent research, in many countries, has consistently confirmed that psychiatric patients have high rates of physical illness, much of which goes undetected. 23 Such investigations have led to calls for health professionals to be more aware of these findings and for better medical screening and treatment of psychiatric patients. So far there is no evidence that this is happening, and the excess illness and mortality continue unabated, with people being managed as psychiatric outpatients being nearly twice as likely to die as the general population.4

People with schizophrenia are subjected to the long term effects of antipsychotic medication and have high rates of substance misuse. Yet much of their excess mortality is due to natural causes. They eat less well, smoke more, and take less exercise than the general population.5 Smoking related fatal disease is …

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